Vulvodynia (persistent vulval pain)

Treatments for vulvodynia

A combination of some of the following treatments can often help relieve symptoms of vulvodynia and reduce its impact on your life:

Therapy and counselling

Surgery

Self-care

The following lifestyle tips may help reduce symptoms of vulvodynia:

Wear 100% cotton underwear and loose-fitting skirts or trousers.
Avoid scented hygiene products such as feminine wipes, bubble bath and soapan emollient is a good substitute for soap.
Apply cool gel packs toyour vulva to soothe the pain.
Use petroleum jelly before swimming to provide protection from chlorine.
Try not to avoid sex or touching your vulva completely, as this may make your vulva more sensitive if sex is painful, try to find a position that's more comfortable, or if penetration is painful do other sexually intimate activities together until you've sought advice.
Try to reducestress, as it can increase the pain of vulvodyniaread some relaxation tips to relieve stress .
For pain when sitting, using a doughnut-shaped cushion can help.

Over -the-counter gels and lubricants

Applying the anaesthetic gel lidocaine to your vulva about 10 minutes before sex may make it more comfortable. To stop the gel getting on your partner, either wipe it off just before having sex or ask your partner to wear a condom (if using condoms, use latex-free ones as latex condoms can be damaged by lidocaine).

If your pain is more constant, applying lidocaine regularly throughout the day may help. Lidocaine can also be used overnight. A tip is to put some on a cotton make-up removal pad and put it onto the sore area so it's held in place by your underwear.

It's very common to have some burning when the lidocaine is initially applied which can last several minutes before going numb. Try to give the lidocaine time it to work, but if the burning continues for 10 minutes, wash it off thoroughly.

Tubes of 5% lidocaine gel, cream or ointment can be bought over the counter from a pharmacy, although it's a good idea to get a doctor's advice before trying it.

Vaginal lubricants and aqueous cream (also available over the counter) may soothe the area and help moisturise the vulva if it's dry. Speak to your pharmacist about these treatments.

Prescription medication

Conventional painkillers such as paracetamol won't usually relieve the pain of vulvodynia. But several medications available on prescription can help, including:

antidepressants called amitriptylineand nortriptylinepossible side effects includedrowsiness, weight gain and dry mouth
anti-epilepsy medicines called gabapentin and pregabalin possible side effects include dizziness , drowsiness and weight gain

Your doctor will probably start you on a low dose and gradually increase it until your pain subsides. You may need to take the medication for several months.

If you havepain in a specific area ofyour vulva, injections of local anaesthetic and steroid medication into a nearby nerve mayprovide temporary pain relief.

Physiotherapy

A physiotherapist can teach you some pelvic floor exercises (such as squeezing and releasing your pelvic floor muscles) to help relax the muscles around your vagina.

Another technique to relax the muscles in the vagina and desensitise it involves using a set of vaginal trainers. These are smooth cones of gradually increasing size and length which can be inserted into your vagina in the privacy of your own home.

Some physiotherapists may also suggest trying TENS (transcutaneous electrical nerve stimulation) to reduce your pain.This is where a machine is used to deliver a mild electrical current to the painful area.

Therapy and counselling

Cognitive behavioural therapy (CBT) is a type of therapy that aims to help you manage your problems by changing how you think and act. It can often help women cope with the impact that vulvodynia has on their life.

CBT focuses on the problems and difficulties you have now, and looks for practical ways you can improve your state of mind on a daily basis.

Psychosexual counselling is helpful when pain is affecting intimacy between you and your partner. This is a type of therapy that aims to address problems such as fear and anxiety about sex, and to restore a physical relationship with your partner.